Stable Asthmatic Patients Research Articles

Maximal exercise capacity, peripheral muscle strength, sleep quality, and quality of life in adult patients with stable asthma

Objective The prevalence of asthma is increasing gradually worldwide. The pathophysiological process of asthma causes some alterations in the respiratory system and decreases oxygen-carbon dioxide exchange and respiration volume. These alterations may affect maximal exercise capacity, peripheral muscle strength, sleep quality, and disease-specific quality of life but have yet to be comprehensively investigated. To compare maximal exercise capacity, pulmonary function, peripheral muscle strength, dyspnea, sleep quality, and quality of life in adult patients with asthma, healthy controls were aimed. Methods Forty-one adult stable asthmatic patients (GINA I–III) and 41 healthy subjects were compared. Exercise capacity (cardiopulmonary exercise test [CPET]), pulmonary function (spirometry), peripheral muscle strength (dynamometer), dyspnea (modified Medical Research Council [mMRC] dyspnea scale), quality of life (Asthma Quality of Life Questionnaire [AQLQ]) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were evaluated. Results Peak VO2, VO2kg, MET, VE, HR, %VE, %HR, VCO2 parameters of CPET, FVC, FEV1, FEF25–75%, and FEV1/FVC and quadriceps femoris, shoulder abductors, and hand grip muscle strength were significantly decreased in patients with asthma (p < 0.05). MMRC dyspnea scale score was increased, and AQLQ and PSQI scores decreased in asthma patients (p < 0.05). Conclusions Cardiac and pulmonary system responses to peak exercise worsened, and maximal exercise capacity and peripheral muscle strength decreased in adult patients with stable asthma. In addition, dyspnea during daily activities increases, and quality of life and sleep quality are impaired. A variety of exercise training that would benefit asthmatic patients’ outcomes should be investigated.

FLUTICASONE FUROATE AND VILANTEROL (FF/VI) VERSUS FLUTICASONE PROPRIONATE AND FORMOTEROL (FP/FM) AS MAINTENANCE THERAPY IN STABLE ASTHMATIC PATIENTS- A COMPARATIVE STUDY

Background: Fluticasone furoate (FF) is a novel long-acting inhaled corticosteroid (ICS). Vilanterol (VI) is a long‐acting beta2‐agonist (LABA) that binds to the beta2‐adrenoceptor on the airway smooth muscle, producing bronchodilation. The corticosteroid fluticasone propionate (FP)and the long-acting β₂-adrenoceptor agonist (LABA) formoterol fumarate (FM) have been combined in a single, pressurized, metered-dose, aerosol inhaler for the maintenance treatment of patients aged ≥12 years with persistent asthma.This study evaluated the efficacy and safety of Fluticasone furoate 100 mcgandVilanterol 6 mcg versus Fluticasone proprionate 250 mcg and Formoterol 25 mcg for 12 weeks in patients with persistent asthma as maintenance therapy. Methods and Materials: A hospital based comparative study was conducted among stable asthmatic patients attended to Santhiram Medical College and General Hospital, Nandyal during January 2024 to June 2024(6months) by using convenient sampling method with sample size 60. Study tool was pre-designed, pre-tested, asthma control questionnaire5 (ACQ5),asthma control test (ACT) and Ask 12 adherence barrier survey. Results: Among 60 patients, 30 patients (Group1) were given Fluticasone furoate and Vilanterol and another 30 patients (Group 2) were given Fluticasone proprionate and Formoterol. All the patients (both the treatment groups) completed the 12 weeks treatment period. Improvements from baseline in 0- to 24-h wmFEV1 were observed with both FF/VI (376 mL) and FP/FM (353 mL) the adjusted mean treatment difference was not statistically significant. There were no differences between 0- to 4-h serial wmFEV1, asthma control test, ACQ5 and Ask 12 adherence barrier survey. There was no difference in reported exacerbations between treatments. Adverse events reported in the present study were not significant. Both treatments were well tolerated. Conclusion: The present study shows that the efficacy of once daily Fluticasone furoate and Vilanterol was not inferior as compared to the efficacy of twice daily Fluticasone proprionate and Formoterol as maintenance therapy in stable asthmatic patients. Howevertreatment with once daily FF/VI has the advantage of forgetfulness and inconvenience of inhalation.Henceonce daily FF/VI can be also useful for stable asthmatic patients as maintenance therapy as FF/VI DPI treatment.

Correlating Cyberchondria and Health Anxiety: Demographic Insights from Stable Asthma Patients

Objective: With the increasing ubiquity of internet, the phenomenon of cyberchondria is becoming progressively widespread in today's digital society. This study investigates the correlation between health anxiety and cyberchondria severity and evaluates the influence of demographic factors in stable asthma patients. Methods: This cross-sectional study incorporated a sample of 51 patients with stable asthma. Sociodemographic data were systematically documented, and participants completed the Health Anxiety Inventory (HAI) and Cyberchondria Severity Scale-12 (CSS-12). Data analyses were performed using IBM SPSS Statistics v.22, Pearson and Spearman correlation analyses were employed to investigate relationships between variables, and multivariate linear regression was used to identify potential predictors of health anxiety. Results: The sample primarily consisted of female (76.5%) and married (74.5%) individuals with a mean age of 41.47 years (SD:12.92). Smokers reported higher median scores in health anxiety compared to non-smokers, with a significant difference (p=0.023), while no significant difference in cyberchondria severity was seen across smoking statuses (p=0.380). A moderate positive correlation between health anxiety and cyberchondria severity scores was also identified (r=0.415, p=0.002). The regression analysis indicated that together, cyberchondria severity, smoking status, and education level accounted for a significant proportion of the variance in health anxiety scores (Adjusted R^2:0.374, p&lt;0.001). Conclusion: The study establishes a connection between health anxiety and cyberchondria severity in patients with stable asthma. The results suggest that health interventions targeting modifiable factors could be beneficial in reducing health anxiety within this patient group.

Aberrant characteristics of peripheral blood innate lymphoid cells in COPD, independent of smoking history.

Distinguishing asthma and COPD can pose challenges in clinical practice. Increased group 1 innate lymphoid cells (ILC1s) have been found in the lungs and peripheral blood of COPD patients, while asthma is associated with elevated levels of ILC2s. However, it is unclear whether the inflammatory characteristics of ILC1s and ILC2s differ between COPD and asthma. This study aims to compare peripheral blood ILC subsets and their expression of inflammatory markers in COPD patients, asthma patients and controls. The study utilised multi-colour flow cytometry to analyse peripheral blood ILC populations in clinically stable COPD patients (n=38), asthma patients (n=37), and smoking (n=19) and non-smoking (n=16) controls. Proportions of peripheral blood inflammatory CD4+ ILC1s were significantly higher in COPD patients than in asthma. Proportions of CD4- ILC1s were increased in COPD patients compared to asthma patients and smoking controls. Frequencies of CD117- ILC2s were significantly reduced in COPD patients compared with asthma patients. In contrast, the fraction of inflammatory CD45RO+ cells within the CD117- ILC2 population was significantly increased. Principal component analyses showed that combined features of the circulating ILC compartment separated COPD patients from asthma patients and both control groups. Our in-depth characterisation of ILC1 and ILC2 populations in peripheral blood revealed significant differences in their phenotypes between COPD and asthma patients and smoking or non-smoking controls. These findings suggest a role for both ILC subsets in COPD disease pathology, independent of smoking history, and may have implications for patient stratification and therapy development.

Changes and clinical significance of serum MMP-9, TIMP-1, COX-2, and immune levels in patients with asthma

Objective: To detect serum metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases (TIMP-1), cyclooxygenase-2 (COX-2), and T helper cells 1–T helper cells 2 (Th1–Th2) levels in asthma patients and assess their clinical significance. Methods: A total of 72 patients experiencing acute asthma (acute group), 66 stable asthma patients (stable group), and 60 healthy volunteers (control group) were included in this study. The levels of TIMP-1, COX-2, and Th1–Th2 in patients with acute asthma were measured following treatment with budesonide aerosol inhalation. In addition, the levels of MMP-9, TIMP-1, COX-2 and Th1–Th2 were compared in patients with different severity of acute asthma before and after treatment. Results: The serum levels of MMP-9, TIMP-1, and COX-2 showed an increasing trend in the control, stable, and acute groups, while levels of Th1–Th2 showed a sequential decreasing trend, and the differences were statistically significant. Comparison of lung function indexes among the three groups of patients established a negative correlation between serum MMP-9 and its forced vital capacity% predicted (FEV%pred), TIMP-1, and COX-2, and FEV%pred and forced expiratory volume in 1 s–forced vital capacity (FEV1/FVC) levels, but a positive correlation between Th1–Th2 and FEV1/FVC levels in the acute group. A significant difference was observed on comparing the levels of serum MMP-9, TIMP-1, COX-2, and Th1–Th2 in patients with different conditions in the acute group. Specifically, as the condition worsened, a significant increase in serum MMP-9, TIMP-1, and COX-2 levels but a significant decrease in Th1–Th2 levels was observed. After treatment, we observed a significant decrease in serum MMP-9, TIMP-1, and COX-2 levels but a significant increase in Th1–Th2 levels in the acute group. Conclusion: The serum levels of MMP-9, TIMP-1, COX-2, and Th1–Th2 are valuable indicators reflecting the condition of asthma patients and could be considered promising clinical monitoring indicators.

Bronchodilator responsiveness testing with inhaled budesonide/formoterol in asthma

Background The choice of bronchodilators for responsiveness testing (BRT) is a clinical decision according to ATS/ERS. Since January 2019 we use budesonide/formoterol for BRT in asthma at our center in Argentina. The aim was to compare budesonide/formoterol with salbutamol for BRT in stable asthmatic patients that were followed up in a short-acting beta2 agonist (SABA)-free asthma center. Methods From the Hospital database, we found for the same patient at least one BRT using salbutamol 200 µg and another with budesonide/formoterol 320/9 µg. Results We found similar BRT between salbutamol and budesonide/formoterol in 101 asthmatic individuals (26 males) aged 38.14 ± 16.1 yrs (mean ± Standard deviation). The absolute response was 0.18 ± 0.21 L in FEV1 after salbutamol and 0.20 ± 0.22 L in FEV1 after budesonide/formoterol. Afterwards, we showed 202 patients tested with budesonide/formoterol; the mean absolute response was 0.21 ± 0.22 L in FEV1. There were no unexpected safety findings. Conclusions In asthmatic patients, we demonstrated similar efficacy between Budesonide/formoterol and salbutamol for BRT.

Delineating asthma according to inflammation phenotypes with a focus on paucigranulocytic asthma.

Asthma is characterized by chronic airway inflammation and airway hyper-responsiveness. However, the differences in pathophysiology and phenotypic symptomology make a diagnosis of "asthma" too broad hindering individualized treatment. Four asthmatic inflammatory phenotypes have been identified based on inflammatory cell profiles in sputum: eosinophilic, neutrophilic, paucigranulocytic, and mixed-granulocytic. Paucigranulocytic asthma may be one of the most common phenotypes in stable asthmatic patients, yet it remains much less studied than the other inflammatory phenotypes. Understanding of paucigranulocytic asthma in terms of phenotypic discrimination, distribution, stability, surrogate biomarkers, underlying pathophysiology, clinical characteristics, and current therapies is fragmented, which impedes clinical management of patients. This review brings together existing knowledge and ongoing research about asthma phenotypes, with a focus on paucigranulocytic asthma, in order to present a comprehensive picture that may clarify specific inflammatory phenotypes and thus improve clinical diagnoses and disease management.

A Study on The Levels of Serum Vitamin D and Magnesium in Asthma Severity

Serum magnesium levels influence the concentration of circulating vitamin D in blood, which in turn influence immunity; thus, it plays an important role in the asthma pathogenesis. Adult asthma is less studied, hypomagnesemia along with the vitamin D deficiency and insufficiency, is common in asthmatic patients, causing frequent attacks of asthma, infections of respiratory tract, severe exacerbations, and poor bronchodilator response. AIMS AND OBJECTIVES: To measure vitamin D insufficiency and deficiency levels, as well as levels of serum magnesium in asthmatic patients, and correlate them with asthma severity. MATERIAL AND METHODS: This is a cross-sectional case-control study with 60 chronic stable asthma patients and 60 healthy controls. A pulmonary function test was performed following the clinical history and systemic examination. All subjects had their serum levels of magnesium, 25-hydroxycholecalciferol [25(OH)D] measured. RESULTS: A significant relationship was observed between vitamin D deficiency, hypomagnesemia, and asthma severity. CONCLUSION: Vitamin D and serum magnesium deficiency are frequent in asthma patients. Lower levels of one or both are associated with increased asthma severity, frequency of attacks, and exacerbation. Serum 25(OH)D and magnesium levels may be useful indicators of asthma severity.

Comparison of Forced Oscillometric Technique and Spirometry in Stable Asthmatic Patients in Central India: A Cross-sectional Study

Comparison of Forced Oscillometric Technique and Spirometry in Stable Asthmatic Patients in Central India: A Cross-sectional Study

The pittsburg sleep quality index in asthmatic patients: A case-control study

Introduction: Sleep disturbances are common in asthmatic patients. The purpose of this study was to evaluate sleep quality in asthmatic patients in local setting. Materials and methods: In the present case-conrol study, sleep quality of asthma patients was assessed using Pittsburgh Sleep Quality Index (PSQI), in 76 clinically stable asthmatic patients at the outpatient clinic compared to 76 healthy subjects in control group. Poor sleep quality is classified as PSQI score more than 5. Results: Mean PSQI score in patients was significanly higher than the control group. The number and percent of cases with poor sleep quality and all subdomains of PSQI score were statistically more than control group. Conclusion: According to the results of the present study, sleep quality of the majority of asthma patients was not desirable. It is necessary for policy makers and health managers as well as physicians to focus on this aspect of the patients’ health as well. It is recommended to have sleep health consultation in pulmonary clinic.

Changes and clinical significance of serum MMP-9, TIMP-1, COX-2, and immune levels in patients with asthma.

To detect serum metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases (TIMP-1), cyclooxygenase-2 (COX-2), and T helper cells 1-T helper cells 2 (Th1-Th2) levels in asthma patients and assess their clinical significance. A total of 72 patients experiencing acute asthma (acute group), 66 stable asthma patients (stable group), and 60 healthy volunteers (control group) were included in this study. The levels of TIMP-1, COX-2, and Th1-Th2 in patients with acute asthma were measured following treatment with budesonide aerosol inhalation. In addition, the levels of MMP-9, TIMP-1, COX-2 and Th1-Th2 were compared in patients with different severity of acute asthma before and after treatment. The serum levels of MMP-9, TIMP-1, and COX-2 showed an increasing trend in the control, stable, and acute groups, while levels of Th1-Th2 showed a sequential decreasing trend, and the differences were statistically significant. Comparison of lung function indexes among the three groups of patients established a negative correlation between serum MMP-9 and its forced vital capacity% predicted (FEV%pred), TIMP-1, and COX-2, and FEV%pred and forced expiratory volume in 1 s-forced vital capacity (FEV1/FVC) levels, but a positive correlation between Th1-Th2 and FEV1/FVC levels in the acute group. A significant difference was observed on comparing the levels of serum MMP-9, TIMP-1, COX-2, and Th1-Th2 in patients with different conditions in the acute group. Specifically, as the condition worsened, a significant increase in serum MMP-9, TIMP-1, and COX-2 levels but a significant decrease in Th1-Th2 levels was observed. After treatment, we observed a significant decrease in serum MMP-9, TIMP-1, and COX-2 levels but a significant increase in Th1-Th2 levels in the acute group. The serum levels of MMP-9, TIMP-1, COX-2, and Th1-Th2 are valuable indicators reflecting the condition of asthma patients and could be considered promising clinical monitoring indicators.

EMPOWERING TELEMEDICINE AS AN EFFORT TO ASSES KNOWLEDGE, ASTHMA SYMPTOMS CONTROL AND RISK FACTORS OF ASTHMATIC PATIENTS IN THE ERA OF COVID-19 PANDEMIC

Introduction: Asthma is heterogenous disease characterized by chronic airway inflammation. COVID-19 pandemic has an impact on health services where telemedicine could provide alternative method to evaluate patient’s condition, reduce risk of infection and disease transmission. The aim of this study is to analysis knowledge, asthma symptoms control and risk factors among the asthmatic patients via telemedicine Methods: Data was obtained from telemedicine of 28 asthmatic patients in the context of community services. Inclusion criteria is stable asthmatic patients who conducted medical interview via videocall application. Cross sectional data were taken including demographic, knowledge of subjects, profile of subjects, and assessment of asthma symptoms control and assessment of poor outcomes. Data were analyzed descriptively and variables were analyzed using chi-square. Results: Subjects consisted of 28 stable asthmatic patients. The average of asthma onset was 17.96 years old. Clinically profile showed that 67.86% subjects were not routinely controlled, 64.29% had never performed pulmonary function test, 67.86% subjects didn’t know the level of asthma control symptoms. Evaluation based on GINA symptoms control only 39.29% were in good control condition, 35.71% were partially controlled and 25% in uncontrolled condition. Use of inhaler device recently or previously prescribed on 67.86% subjects. Evaluation of knowledge about asthma still unsatisfactory, 67.86% subjects didn’t know about their modifiable risk factors, 96.43% didn’t know about written action asthma plan, 60.71% didn’t know about asthma exercise. Self-medication was associated with poor asthma control (p=0,036) and knowledge about modifiable risk factors related to asthma symptoms control (p=0,041). Conclusion: Self-medication is related to uncontrolled asthma and knowledge of modifiable factors is related asthma symptoms control. It is important to educate the patient about the modifiable risk factors of asthma and how to manage it. Patient knowledge about their disease is still lacking, and there is a need for ongoing education to achieve good asthma control. Alternative intervention through telemedicine especially for continuing education and may therapeutic strategies can be performed as an effort to obtain well controlled asthma in community. Telemedicine, particularly in asthma management may benefit as an alternative approach of healthcare service in the context of pandemic era.

Non-invasive diagnostics of pathogenic bacteria using a breath sampler in children with cystic fibrosis

Cystic fibrosis (CF) is a common autosomal recessive disease causing thick, viscous secretions leading to pulmonary infections with pathogenic bacteria. As part of routine patient care, colonization and infection with these bacteria is monitored with cough swab or sputum cultures and sometimes bronchoalveolar lavage. In this cross-sectional proof-of-concept study in a cohort of CF patients we collected swabs or sputa and exhaled breath samples with the modular breath sampler (MBS), a newly developed two-way non-rebreathing sampling device. Pathogen specific polymerase chain reactions (PCRs) were performed on the MBS samples and compared with the results obtained with conventional diagnostics (i.e. culturing of swabs and sputa). A control group of stable asthma patients was used as negative control for the MBS measurements. The pathogens detected using MBS and conventional culturing differed: S. aureus was found more often in swab or sputum samples whereas Pseudomonas aeruginosa and S. pneumoniae were found more often in MBS samples. We hypothesize that this is due to sampling of different compartments, MBS samples are derived from the lower respiratory tract while cultures from cough swabs and sputa are dominated by pathogens residing in the upper respiratory tract. Another important difference is the readout, i.e. culture versus PCR. The majority of CF patients in whom P. aeruginosa was found did not have recent positive cultures suggesting higher sensitivity of MBS-based than conventional diagnostics. The majority of parents/patients found the MBS easy to use and less of a burden than respiratory sampling.

Does kinesiophobia limit physical activity and quality of life in asthmatic patients?

Kinesiophobia has been studied in musculoskeletal and neurological diseases. The aim of this descriptive study was to assess the level of kinesiophobia in stable asthmatic patients, and to determine whether it is an obstacle to physical activity and quality of life. A total of 62 asthmatic patients and 50 healthy control subjects were assessed using the tampa kinesiophobia scale (TSK) for kinesiophobia, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity levels, and Asthma Quality of Life Questionnaire (AQLQ) for quality of life. A high degree of kinesiophobia was determined in 54.8% of the asthmatic patients. The TSK scores were significantly higher ( P < 0.001), and the AQLQ scores were lower in the asthma group than in the control group ( P < 0.001). The IPAQ-SF level and AQLQ score were lower ( P < 0.001 for both) in the asthmatic group with a high kinesiophobia score. The TSK score was significantly associated with IPAQ-SF score ( r = -0.889; P < 0.001) and AQLQ score ( r = -0.820; P < 0.001) in asthmatic patients. According to linear regression analysis, kinesiophobia explained 84.40% of QoL and physical activity. Patients with a stable asthma were observed to have a high level of kinesiophobia compared with healthy subjects. High kinesiophobia levels may increase the disease burden by negatively affecting participation in physical activity and quality of life. While developing asthma education programs for asthma patients, it should be remembered that even in the stable period, kinesiophobia can develop. Preventive and therapeutic programs should include precautions to improve quality of life and physical activity against the effects of kinesiophobia.

Assessment of plasma lipid parameters, exhaled nitric oxide fraction, and systemic immune-inflammation index on stable asthma patients

Asthma is a chronic disease characterized by the presence of inflammatory agents in the airways, and diagnosis and treatment are based on clinical questioning, physical examination, laboratory results, and spirometric analysis. This study investigated the effect of asthma alone on routine laboratory parameters in adults and whether an idea about the course of the disease can be obtained using these parameters. Two hundred and fourteen patients with known asthma history, diagnosed, and treated according to guidelines, were included in our study. Among all patients and between gender-specific groups, total cholesterol (CHOL), HDL, LDL, VLDL, triglyceride (TG), albumin, total protein (TP), lactate dehydrogenase (LDH), glucose, urea, creatinine, C reactive protein (CRP), FeNO, SII, INR, and complete blood count value parameters of the patients were analyzed. When we consider all asthma patients, we found that the mean glucose, LDH, CRP, TG, FeNO, and INR values outpaced the upper limit of the reference range. In contrast, the mean HDL value was below the reference range for all patients. In addition, our study found a significant correlation between triglyceride levels within the biochemical parameters with FeNO and SII). Finally, when we compared the mean values of gender-specific groups, we found a statistically significant difference between VLDL, HDL, TG, CRP, FeNO, creatinine, lymphocyte, eosinophile, basophile, and hemoglobin. CRP, LDH, TG, FeNO, SII, and INR levels may help clinicians in adult patients with stable asthma. In addition, differences depending on gender could be observed in the biochemical parameters of asthma patients.

Comprehensive assessment of the relation between clinical symptoms, functional parameters and biomarkers of airway inflammation

Background: Asthma is a chronic inflammatory disorder of the airways causing bronchial hyper-responsiveness that is characterized by variable and recurring symptoms and airflow obstruction. Asthma is characterized by multiple biomarkers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain and cost-effective. bjective: The current study aimed to assess the relation between clinical symptoms, functional parameters and biomarkers of airway inflammation. Materials and Methods: This prospective, observational and single-center study carried out in the outpatient and inpatient department of Thoracic medicine, Tirunelveli Medical College Hospital, Tamil Nadu, India from June-2017 to June-2018 was aimed to assess the relation between clinical symptoms, functional parameters and biomarkers of airway inflammation in all stable asthmatic patients of 18–60 years of age. The severity of asthma was assessed according to the GINA criteria, based on clinical symptoms and pulmonary function test. Blood samples were collected for absolute eosinophil count and induced sputum samples for eosinophil count. Data was entered in Microsoft Excel and statistical analysis was performed by t-test. p&lt;0.05 was considered statistically significant.

The Correlations Between Measurement of Lung Diffusing Capacity for Carbon Monoxide and The Severity Group of Asthma Patients in Persahabatan Hospital Jakarta

Introduction: Airway remodeling in asthma which involve small airway can affect until alveoli and cause abnormalities in the lung parenchyma. This study tries to find lung parenchymal abnormalities in patients with asthma through the examination diffusion capacity with a single breath DLCO method.Methods: A cross-sectional study by dividing asthma based on the degree of severity into two major groups, namely mild asthma (intermittent and mild persistent) and severe (persistent moderate and severe). The amount of each group is 31 subjects and 29 subjects, which are taken consecutively from stable asthma patients without comorbid who are seeking treatment in Persahabatan Hospital in December 2015 - May 2016.Results: The average value of DLCO /predictions in mild asthma group is 92,74 ± 15,70% and decreased in the severe asthma group is 77,45 ± 16,78%. Some spirometry value showed significant positive correlation with the value of DLCO/prediction, namely: FVC/prediction, FEV1 /prediction and FEF25-75 % / prediction with p &lt; 0.05. Correlation analysis showed FVC/prediction could dramatically affect the diffusion capacity of asthmatic patients. There is a significant relationship between abnormalities in lung function (p=0,004) and severity of asthma (p=0.000) with a corresponding decrease DLCO / prediction (DLCO/ prediction ≤75 %).Conclusion: The severity of asthma has a relationship with the diffusion capacity of the lungs, increased severity will decrease the diffusion capacity in asthma patients. Decreasing diffusion capacity showed that abnormalities in asthma not only occur in the respiratory tract but also in the lung parenchyma.

Endothelial Dysfunction and Pentraxin-3 in Clinically Stable Adult Asthma Patients.

Asthma is associated with low-grade systemic inflammation, prothrombotic state, and premature atherosclerosis. Objective: To evaluate the relationships between asthma, inflammatory biomarkers, and parameters of endothelial dysfunction. We analyzed flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasound in 92 clinically stable adult asthmatics and 62 well-matched controls. We also measured blood levels of selected inflammatory and asthma-specific biomarkers, including interleukin (IL) 4, IL-5, IL-6, IL-10, IL-12 (p70), IL-17A, IL-23, and interferon γ, as well as a disintegrin and metalloproteinase domain-containing protein 33 (ADAM-33). In addition, we assessed endothelial damage using 2 laboratory biomarkers: circulating von Willebrand factor (vWF) and pentraxin-3. We analyzed relationships between the study variables and asthma severity, lung function abnormalities, airway remodeling indices on computed tomography, and transthoracic echocardiography parameters. Asthmatics had higher IL-6, IL-10, and ADAM-33 levels. They were also characterized by 23% lower FMD% and 15% thicker IMT, as compared with controls (P<.001, both). In asthma, vWF was related to age (ß=0.28 [95%CI, 0.15-0.41]) and remained inversely associated with FEV1 (ß=-0.2 [95%CI, -0.05 to -0.35]). Surprisingly, a negative correlation was revealed between vWF and pentraxin-3 (ß=-0.17 [95%CI, -0.3 to -0.04]). Pentraxin-3 remained positively associated with airway remodeling indices. Asthma is characterized by endothelial dysfunction associated with airway obstruction. The biological role of pentraxin-3 is unknown, although our data suggest a protective role against endothelial damage and atherosclerosis.

Regulatory T cell deficiency in patients with eosinophilic asthma

Background: There is a lack of information about regulatory T cells (Tregs) and inflammatory phenotypes in patients with asthma. In this study, we aimed to compare the characteristics of Tregs in patients with eosinophilic asthma.Methods: Forty healthy and 120 stable asthmatic patients were recruited. Sputum and airway inflammatory phenotypes were assessed, and all patients were followed for one year. Human peripheral blood mononuclear cells (PBMCs) were collected and stimulated with phytohemagglutinin (PHA) and Dermatophagoides farina (Derp) to detect CD4+CD25+FOXP3+T cells and Foxp3 levels. Interleukin (IL)-13, IL-5, IL-17, IL-9, and interferon (IFN)-γ levels were measured.Results: 38.33% of patients had eosinophilic asthma, 13.33% had neutrophilic asthma, 6.67% had mixed granulocytic asthma, and 41.67% had pauci-granulocytic asthma. The eosinophilic asthma patients had a relatively high Asthma Control Test (ACT) score, an increased prediction and improvement FEV1 (%) rate, and elevated total IgE serum levels (P < 0.05). T helper cell 2 (Th2) cytokines IL-13 and IL-5 were predominantly expressed in the eosinophilic phenotype, while the Th1 cytokine IFN-γ and Th17 cytokine were found in the neutrophilic phenotype. IL-10 was significantly lower in eosinophilic asthmatic patients compared to the controls (P < 0.05). CD4+CD25+FOXP3+T cells (%Tregs) and Foxp3 gene expression in the PHA stimulated eosinophilic asthma samples were significantly lower compared to the control samples (P < 0.05). The airway inflammation phenotypes remained stable after one-year of therapy.Conclusion: Asthmatic patients with the eosinophilic phenotype in this study were deficient in Tregs, as characterized by a Th2 cell-biased pattern.

Two-minute tidal breathing methacholine bronchial challenge: Comparison of two jet nebulisers.

The American Thoracic Society (ATS) guideline for methacholine challenge testing (MCT) recommended using the English Wright (EW) nebuliser. However, other brands of nebulisers are also indicated to be acceptable for this technique, but further validation of nebuliser performance is recommended. To compare the methacholine provocation concentration causing a 20% fall in forced expiratory volume in 1 second (PC20 -FEV1 ) measured by using EW nebuliser and DV 646 nebuliser. Subjects were randomly assigned to undergo 2-min tidal breathing methacholine challenge with either EW or DV 646 nebuliser on two separate days, which were at least 24 hours but not more than 7 days apart. The above procedure was repeated for each subject in 1 month, but the nebulisers were selected in a reverse order. The study includes 15 mild and stable asthmatic patients. The geometric means (SD) of methacholine PC20 measured with using EW and DV 646 nebulisers were 1.82 (6.38) mg/mL versus 0.83 (1.82) mg/mL, respectively in the initial two visits and 2.56 (6.29) mg/mL versus 0.78 (1.40) mg/mL in the following two visits (both P < 0.05). There are well correlations between PC20-EW1 and PC20-EW2 (r=0.99, P<0.01), PC20-DV1 and PC20-DV2 (r=0.88, P<0.01), and between PC20-EW1 and PC20-DV1 (r=0.91, P<0.01), PC20-EW2 and PC20-DV2 (r=0.78, P<0.01). PC20 -FEV1 measured by using the two conventional jet nebulisers was both repeatable and the results were highly correlated.